Decision support for computed tomography in the emergency department: a multicenter cluster-randomized controlled...

Area of Science:

• Radiology
• Health Informatics
• Emergency Medicine

Background:

• Clinical decision support systems (CDSS) aim to improve evidence-based imaging practices.
• Previous studies on CDSS impact often lack rigorous randomized designs.
• Reducing unnecessary computed tomography (CT) utilization is a key healthcare goal.

Purpose of the Study:

• To evaluate the effectiveness of a voluntary CDSS in reducing CT utilization for mild traumatic brain injuries and pulmonary embolism in emergency departments.
• To assess the impact of CDSS on CT head and CT pulmonary angiography utilization and diagnostic yield.

Main Methods:

• A cluster-randomized trial involving 225 physicians across five urban emergency departments.
• Voluntary CDSS intervention for CT imaging decisions in head injury and pulmonary embolism cases over a 1-year period.
• Primary outcomes: CT head and CT pulmonary angiography utilization; Secondary outcome: CT pulmonary angiography diagnostic yield.

Main Results:

• Physician participation in the CDSS was 38.0% for head injuries and 45.0% for pulmonary embolism.
• No significant reduction in CT head utilization (OR 0.93) or CT pulmonary angiography utilization (OR 0.98) was observed.
• Diagnostic yield for CT pulmonary angiography was 17.7%, higher than some previous reports, suggesting baseline selective imaging.

Conclusions:

• Voluntary CDSS did not significantly decrease CT utilization or improve diagnostic yield in this setting.
• Low physician engagement and high baseline selective imaging rates were identified as limitations.
• Future interventions must demonstrate clear clinical workflow value to effectively change imaging practices.